House of Lords - Mental capacity
13 March 2014
A report today publishes the findings of a House of Lords Committee, which convened to consider and report on the Mental Capacity Act 2005.
SCIE's Chief Executive, Tony Hunter, says:
The House of Lords Select Committee report on the Mental Capacity Act and Deprivation of Liberty Safeguards provides an insightful analysis of this complex area. SCIE agrees that embedding the principles of the Act, and ensuring that people are not deprived unnecessarily of their liberty is at the heart of a personalised care system which treats people with dignity and respect.
From SCIE's work with services, we know that they are finding putting the Act and DOLS into practice challenging. We will continue to work with the sector to improve their knowledge and skills in this area. Our extensive guides, elearning materials, Social Care TV films and bespoke training on MCA and DOLS continue to be popular.
Thanks for bringing our attention to this Steve I will also post this on our dignity in action Facebook page.
Although I've only read the press reports about the Parliamentary Report, I am not at all surprised that it found that many professionals seem to not understand the Mental Capacity Act (MCA).
The report seems to have been mainly concerned with Deprivation of Liberty Safeguards (DOLS), whereas I'm bothered by end-of-life (EoL) behaviour. However, for my EoL concerns, there are numerous MCA-connected issues around Advance Decisions, who can make what decisions, and what section 4 MCA 'best interests' actually 'means'. There is also a significant complication introduced by section 42, which is very 'tricky' re both lay-professional and professional-professional interactions.
For my issues around EoL patients who are at home, the situation is that frequently only the patient and other family and friends (whoever is living with the patient) will be present when a decision is being discussed or needs making: my solution to the problems that introduces, is something I call the Core Care Team, described in the file awaiting approval in 'poser no 8' in this discussion forum at:
The parliamentary team seem more concerned with residents of care homes and hospitals, where frequently decisions are called for when only the patient/resident and professionals are present. This is a situation in which the 'professional liking for or dependence upon' defined protocols and hierarchies, and 'procedural robustness', frequently clashes with the 'spirit of' the Mental Capacity Act: especially if a quick and 'new' decision needs to be made, which wasn't foreseeable or foreseen.
However, in any setting, there is a lot of 'projection of [existing] belief' onto the MCA: for example, section 1(2) of the MCA, its first guiding principle, is that mental capacity must be assumed present unless the lack of mental capacity has already been established - it takes no time at all, before professionals distort this to 'once mental capacity has been established'. It is mental incapacity, which has to be proven (this is a particular issue, with written 'historical' Advance Decisions').
There is also rampant confusion, as far as I can see, between mental capacity, and the different concept of mental health.
NICE has just thrown its hat into the ring, with some guidance about medication and care homes (NICE has pointed out that mentally capable residents decide whether or not to take an offered medication, exactly as mentally capable patients living in their own homes would).
This was a topic that came up at the workshop I was at yesterday at the Skills for Care annual conference. It does seem that there is a real need for some support and simple tools that will guide individuals through the process. The general feel in the discussion seemed to be that once you had got the concepts and saw it as an enabling rather than disabling piece of legislation it opened rather than closed doors.